Examining the Traits-Desires-Intentions-Behavior (TDIB) Model for Fertility Planning in Women Living with HIV in Ontario, Canada

The objective of this study was to determine the predictors of fertility behavior (i.e., trying to become pregnant) in a large representative sample of women living with HIV of reproductive age in Ontario, Canada. The Traits-Desires-Intentions-Behavior model was used to examine the key predictors of reproductive decision making and behavior. A total of 320 women living with HIV were included in the current analysis. The women living with HIV were between the ages of 18 and 52 (mean=37.23, SD=7.53), 56.4% had at least one child living in the home, over 40% identified as being of African ethnicity, and the average time since HIV diagnosis was 10.49 years (SD=5.71). In hierarchical multilevel analysis, perceived family support for trying to become pregnant, living in a large metropolitan city (i.e., Toronto), women's fertility desires, and fertility intentions were associated with fertility behavior (χ(2)9=59.97, p<0.001). As only 10.6% of participants reported engaging in fertility-related behavior, while 57.5% intended a pregnancy in the future, identifying barriers to fertility and discrepancies between intentions and behaviors can support policy programs and assist health care providers to better facilitate the fertility goals of women living with HIV.</p

Overview of focus group participants' (<i>n</i> = 104) descriptions of coping strategies.

<p>Focus group key: 1, African Caribbean (Ottawa); 2, African Caribbean (Toronto); 3, Asian and South Asian; 4, formerly incarcerated; 5, Francophone; 6, injection drug use; 7, Latina; 8, LBQ; 9, Northern Ontario medium-sized city; 10, Northern Ontario small-sized city; 11, sex work; 12, South Western Ontario medium-sized city; 13, transgender; 14, urban; 15, young women.</p

Overview of focus group participants' (<i>n</i> = 104) descriptions of stigma and discrimination.

<p>Focus Group Key: 1, African Caribbean (Ottawa); 2, African Caribbean (Toronto); 3, Asian and South Asian; 4, formerly incarcerated; 5, Francophone; 6, IDU; 7, Latina; 8, LBQ; 9, Northern Ontario medium-sized city; 10, Northern Ontario small-sized city; 11, sex work; 12, South Western Ontario medium-sized city; 13, transgender; 14, urban; 15, young women.</p

Overview of focus groups (<i>n</i> = 15).

<p>Overview of focus groups (<i>n</i> = 15).</p

Sociodemographic characteristics of focus group participants (<i>n</i> = 104).

a<p>The <i>n</i> is lower due to missing responses.</p

A Psycho-Educational HIV/STI Prevention Intervention for Internally Displaced Women in Leogane, Haiti: Results from a Non-Randomized Cohort Pilot Study

<div><p>Background</p><p>Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo) (Women Taking Action For Their Health) study examined the effectiveness of a peer health worker (PHW) delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti.</p><p>Method</p><p>This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829).</p><p>Results</p><p>Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88%) completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (β = 4.81; 95% CI 4.36–5.26), STI knowledge (β = 0.84; 95% CI 0.70–0.99), condom use (AOR = 4.05, 95% CI 1.86–8.83), and depression (β = −0.63, 95% CI −0.88–−0.39) scores showed statistically significant change post-intervention (p<0.05).</p><p>Conclusions</p><p>This pilot study evaluated a PHW psycho-educational HIV/STI prevention intervention among internally displaced women in post-earthquake Haiti. Pilot studies are an important approach to understand feasibility and scientific impacts of HIV prevention strategies in disaster contexts. Study results may inform HIV prevention interventions among internally displaced women in Haiti and can be tested for applicability with internally displaced women globally.</p><p>ClinicalTrials.gov: Identifier NCT01492829, URL: <a href="http://clinicaltrials.gov/ct2/show/NCT01492829?term=logie&rank=1" target="_blank">http://clinicaltrials.gov/ct2/show/NCT01492829?term=logie&rank=1</a></p></div

Parameter Estimates for Final Path Model in African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2011 (n = 157).

<p>Parameter Estimates for Final Path Model in African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2011 (n = 157).</p

Socio-demographic characteristics of intervention participants (n = 176).

<p>Socio-demographic characteristics of intervention participants (n = 176).</p

Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.

<p>Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.</p

Socio-demographic Characteristics of Survey Participants (n = 173) by Ethnicity in the African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2010–2011.

<p>Socio-demographic Characteristics of Survey Participants (n = 173) by Ethnicity in the African and Caribbean Black Women’s Stigma and Health Study: Ontario, Canada, 2010–2011.</p